Breath-holding spells

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By Robert P Turner MD

Breath-holding spells, described more than 400 years ago, are paroxysmal clinical events that occur between the ages of 6 months and 4 to 6 years, in which vigorous crying is interrupted by end-expiratory apnea, followed by cyanosis or pallor, loss of consciousness, and occasionally by a clonic seizure or myoclonic movements. Though virtually always triggered by a stimulus (pain, fear, or anger), the misconception still exists that the child “does it on purpose.” They are terrifying to parents or care-givers but are often dismissed by clinicians in a cavalier manner, due to their benign long-term outcome and the misconception that they occur in “spoiled children.” Relatively rare sequelae of breath-holding spells are seizures, occurring at the end of the spell. Anecdotal reports exist of supplemental iron or blowing in a child’s face being helpful in aborting episodes. This clinical article reflects new studies regarding presumed autonomic dysregulation and the association of iron-deficiency anemia in some children with breath-holding spells.